Provider Demographics
NPI:1407986854
Name:COUNTY OF SWEET GRASS
Entity Type:Organization
Organization Name:COUNTY OF SWEET GRASS
Other - Org Name:PIONEER MEDICAL CENTER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-932-4603
Mailing Address - Street 1:PO BOX 1228
Mailing Address - Street 2:
Mailing Address - City:BIG TIMBER
Mailing Address - State:MT
Mailing Address - Zip Code:59011-1228
Mailing Address - Country:US
Mailing Address - Phone:406-932-4199
Mailing Address - Fax:406-932-5468
Practice Address - Street 1:701 STOCK STREET
Practice Address - Street 2:SUITE C
Practice Address - City:BIG TIMBER
Practice Address - State:MT
Practice Address - Zip Code:59011
Practice Address - Country:US
Practice Address - Phone:406-932-4603
Practice Address - Fax:406-932-5468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000080224Medicare ID - Type Unspecified